Breast Care A-Z · Procedure · MASTECTOMY

Mastectomy

also: simple mastectomy, total mastectomy, skin-sparing mastectomy, nipple-sparing mastectomy, bilateral mastectomy · pronounced ma-STEK-to-mee

A mastectomy is surgery to remove all of the breast tissue, used to treat breast cancer or to reduce risk in high-risk women, and it can often be combined with reconstruction. You have probably been told it is one of your options, or are reading to understand what the decision will involve.

Quick answers

Is mastectomy a "bigger" operation than lumpectomy?

Yes — mastectomy is a larger operation with a longer hospital stay and recovery, particularly when combined with reconstruction. But for the cancers it treats, the long-term survival outcomes are equivalent to lumpectomy plus radiotherapy. The choice between the two is rarely about which is "better" but about which is the right operation for the specific cancer and patient.

Do I have to have reconstruction?

No. Reconstruction is a personal choice. Some patients want immediate reconstruction; some prefer to delay; some choose [aesthetic flat closure](/services/reconstruction/aesthetic-flat-closure/), which is a deliberate surgical option rather than the absence of a choice. All three are valid.

Will I need radiotherapy after mastectomy?

Most patients who have a mastectomy do not need radiotherapy — that is one of the reasons mastectomy is sometimes preferred. Some do, particularly with larger tumours or significant lymph node involvement. The need for radiotherapy is decided by the [multidisciplinary team](/glossary/multidisciplinary-team/) based on the cancer's biology and the operation's findings.

BREASTORY ENCYCLOPEDIA · PLATE XLIV SURGERY · OPERATIVE PROCEDURES mastectomy total mastectomy · modified radical mastectomy · risk-reducing mastectomy surgical removal of the breast for cancer treatment or risk reduction, with immediate or delayed reconstructive options i FIG 01 Surgical Diagram · Anterior Chest View · Axillary Anatomy ANTERIOR CHEST VIEW NAC removed skin flap pectoralis major LEFT — mastectomy RIGHT — intact SLN Axillary chain i Elliptical incision (horizontal/oblique) ii Skin flap elevation (skin-to-breast plane) iii Pectoral fascia plane (deep dissection) iv Nipple-areola complex (removed) v Axillary dissection / sentinel node TYPES OF MASTECTOMY Simple (total): all breast + NAC + skin ellipse Modified radical: + axillary node clearance Skin-sparing: breast + NAC; skin preserved Nipple-sparing: tissue only; NAC preserved Prophylactic: bilateral in BRCA high-risk AXILLARY MANAGEMENT Clinically node-negative → SLNB first SLNB positive (macro) → ALND Pre-op node+ → Direct ALND or neoadjuvant then reassess ii FIG 02 Simple vs Modified Radical Mastectomy Parameter Simple (total) Modified radical Tissue removed Breast + NAC + skin ellipse + Axillary lymph nodes Pectoral muscles Preserved Preserved (modified) Axillary surgery Not included Level I–III clearance Indication Small/multifocal; prophylactic Node-positive disease Reconstruction Immediate or delayed Immediate or delayed Drain requirement 1 drain 1–2 drains Hospital stay 1–2 days 2–3 days Complication Seroma, wound infection + Lymphoedema Sensory loss Chest wall Chest wall + arm Prognosis Equivalent to WLE+RT Stage-dependent iii FIG 03 Mastectomy vs Wide Local Excision — Equivalence Data Outcome Mastectomy WLE + radiotherapy Overall survival Equivalent Equivalent Local recurrence ~5% (10-yr) ~5–10% (10-yr) Cosmesis Requires reconstruction Breast preserved Radiotherapy Usually not required Required Hospital stay 1–3 days 1 day Psychological impact Body image concerns Less impact Re-operation Reconstruction stages ~20% re-excision Patient preference ~30% ~70% Eligibility All patients Tumour:breast ratio dep. iv FIG 04 Surgical Pathway and Decision Points 1 MDT decision tumour/patient factors 2 Informed consent + reconstruction discussion 3 Pre-operative marking 4 Mastectomy ± SLNB/ALND 5 Specimen histology margins 6 Adjuvant chemo/hormone/RT v FIG 05 Mastectomy Types Reference Simple mastectomy (total) Modified radical + ALND Skin-sparing + reconstruction Nipple-sparing NAC preserved Prophylactic bilateral (BRCA) Completion mastectomy vi FIG 06 Key Statistics · Mastectomy ~30% of UK breast cancer ops [1] =BCS+RT equivalent survival [2] ~10% overall complication rate [3] ~40% choose reconstruction [4] vii FIG 07 References 1. NHS England. Cancer services data 2023 2. Fisher B et al. NSABP B-06 twenty-year follow-up. NEJM 2002;347:1233 3. NICE NG101. Early breast cancer guidelines 2023 4. NHS Digital. Breast surgery outcomes 2022 5. Veronesi U et al. 20-yr results Milan trial. NEJM 2002;347:1227 Clinically authored by Dr Fiona Tsang-Wright , FRCS (Gen Surg) GMC 4549831 · ORCID 0000-0003-4801-026X
Visual Reference · Mastectomy
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Definition
A mastectomy is the surgical removal of the whole breast — the breast tissue and, depending on the type, some or all of the overlying skin and nipple — performed to treat breast cancer or to reduce the future risk of breast cancer in patients with high genetic or family-history risk.

Common questions The questions patients ask first

Is mastectomy a "bigger" operation than lumpectomy?
Yes — mastectomy is a larger operation with a longer hospital stay and recovery, particularly when combined with reconstruction. But for the cancers it treats, the long-term survival outcomes are equivalent to lumpectomy plus radiotherapy23. The choice between the two is rarely about which is "better" but about which is the right operation for the specific cancer and patient4.
Do I have to have reconstruction?
No. Reconstruction is a personal choice. Some patients want immediate reconstruction; some prefer to delay; some choose [aesthetic flat closure](/services/reconstruction/aesthetic-flat-closure/), which is a deliberate surgical option rather than the absence of a choice. All three are valid.
Will I need radiotherapy after mastectomy?
Most patients who have a mastectomy do not need radiotherapy — that is one of the reasons mastectomy is sometimes preferred. Some do, particularly with larger tumours or significant lymph node involvement. The need for radiotherapy is decided by the [multidisciplinary team](/glossary/multidisciplinary-team/) based on the cancer's biology and the operation's findings.
Will I lose sensation in the chest?
Significant loss or change of sensation in the chest wall, and (where preserved) the nipple, is expected after mastectomy. Some sensation may return over months to years, but full pre-operative sensation typically does not. This is important to understand when considering nipple-sparing technique, particularly for risk-reducing surgery.

A mastectomy is the surgical removal of the whole breast — the breast tissue and, depending on the type, some or all of the overlying skin and nipple — performed to treat breast cancer or to reduce the future risk of breast cancer in patients with high genetic or family-history risk.

Mastectomy is one of the two main breast cancer operations, alongside lumpectomy. The choice between the two is made on the basis of the cancer’s size, position, and biology, the patient’s anatomy, and personal preference. Most modern mastectomies preserve the breast skin envelope (skin-sparing) or the skin and nipple together (nipple-sparing) so that immediate reconstruction can give a good cosmetic result.

Orientation Why you might be reading about this

You have probably been told that mastectomy is one of the options in your treatment plan, or you are reading to understand what your decision will involve. Mastectomy is a significant operation, but it is also one with well-defined options — particularly around reconstruction — that should be laid out fully at consultation. This page explains what mastectomy is, the different types, and how the decision is usually made.

Related terms: Lumpectomy · Sentinel lymph node biopsy · DIEP flap · Breast lump · DCIS

Mastectomy types Types of mastectomy

There are four common types of mastectomy1. The right one for you depends on the cancer (or, in risk-reducing surgery, the genetic and anatomical picture), what reconstruction is planned, and the patient’s preferences:

Simple (total) mastectomy

Removes all the breast tissue together with the overlying skin and the nipple. Leaves a flat chest wall with a horizontal scar across it. Used when reconstruction is not chosen — see aesthetic flat closure — or where the cancer’s position or skin involvement means the skin and nipple cannot be preserved.

Skin-sparing mastectomy

The breast tissue and nipple are removed through a smaller incision, but most of the breast skin envelope is kept. The preserved skin envelope is then filled with an implant or autologous tissue at the same operation, giving a more natural-looking result than reconstruction performed on a tightly closed chest wall.

Nipple-sparing mastectomy

Removes the breast tissue but preserves both the skin envelope and the nipple-areolar complex. Suitable when the cancer is not close to the nipple and there are no signs of nipple involvement. Gives the most natural-looking outcome when paired with immediate reconstruction.

Risk-reducing (prophylactic) mastectomy

Performed on healthy breast tissue to reduce future cancer risk in patients with a high-risk genetic mutation (such as BRCA1 or BRCA2) or a strong family history. Almost always bilateral, almost always with skin-sparing or nipple-sparing technique and immediate reconstruction. See risk-reducing mastectomy.

A second decision sits alongside the type: immediate reconstruction at the same operation, delayed reconstruction months or years later, or no reconstruction (aesthetic flat closure). All three are reasonable choices and the right one depends on the cancer, the radiotherapy plan, and the patient4.

SLNB Sentinel lymph node biopsy

For invasive cancers, mastectomy is usually combined with sentinel lymph node biopsy — a separate small operation in the armpit at the same time, to assess whether the cancer has spread to the lymph nodes4. For DCIS being treated with mastectomy, sentinel biopsy is often (though not always) included as part of the operation4.

Recovery Recovery

  • Hospital stay typically 1–2 nights for mastectomy with implant-based reconstruction; 4–5 nights for autologous reconstruction; usually 1 night for mastectomy without reconstruction1.
  • Drains stay in for around 1–2 weeks, removed in clinic1.
  • Most desk-based work is resumed at 4–6 weeks; physical work later1.
  • Full activity including upper-body exercise typically returns at three months for implant-based reconstruction; longer for autologous1.

The cosmetic and functional outcome continues to settle for 6–12 months after the operation1, particularly when reconstruction is part of the plan.

Afterwards After mastectomy

The breast tissue removed at mastectomy is examined in detail by a pathologist; the final histology often refines the picture compared to the pre-operative biopsy. The case is then reviewed at a multidisciplinary team meeting to confirm any additional treatment needed — radiotherapy, chemotherapy, hormone therapy, or targeted therapy — based on the operation’s findings rather than the pre-operative imaging alone4.

Most patients who have had mastectomy do not need radiotherapy (one of the reasons mastectomy is sometimes preferred over lumpectomy). Some do — particularly with larger tumours or significant lymph node involvement4.

At consultation What to discuss with your surgeon

If mastectomy has been recommended, the conversation usually covers:

  • Why mastectomy rather than lumpectomy, with the trade-offs in survival, recurrence risk, and cosmetic outcome.
  • Type of mastectomy — simple, skin-sparing, or nipple-sparing — and what each preserves.
  • Reconstruction — immediate or delayed, implant-based or autologous, or aesthetic flat closure as a deliberate choice.
  • Sensation, breastfeeding, and other practical implications — these are honest conversations that matter for life after the operation.

For the practice’s full mastectomy service page, see mastectomy.

Resources Further reading

Sources & guidance

Every figure on this page is anchored to a published source. Tap a number in the text or below to jump to the reference.

  1. guidance Association of Breast Surgery (ABS). Best Practice Guidelines: surgical management of breast cancer. London: ABS. 2022 https://www.nice.org.uk/guidance/ng101 Cited for: UK best-practice for mastectomy types, skin-sparing and nipple-sparing technique, sentinel-node biopsy at mastectomy, drains and recovery.
  2. rct Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. New England Journal of Medicine. 2002 ;347(16):1227–1232 doi:10.1056/NEJMoa020989 Cited for: Long-term equivalence of breast-conserving surgery + radiotherapy vs mastectomy in early breast cancer — the rationale for offering BCS as an equivalent oncological option.
  3. rct Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer (NSABP B-06). New England Journal of Medicine. 2002 ;347(16):1233–1241 doi:10.1056/NEJMoa022152 Cited for: Equivalent overall and disease-free survival between mastectomy and lumpectomy + radiotherapy at 20 years (companion landmark trial to Veronesi).
  4. guideline National Institute for Health and Care Excellence (NICE). Early and locally advanced breast cancer: diagnosis and management (NG101). London: NICE. 2018 ;Last updated 2024 https://www.nice.org.uk/guidance/ng101 Cited for: UK pathway for choice between mastectomy and BCS; indications for post-mastectomy radiotherapy; offer of immediate vs delayed reconstruction.